Main Body
The gynaecology department at Glan Clwyd Hospital provides a service
for women who are experiencing difficulties in early pregnancy. The most
common emergencies that present onto the ward are women with
threatened and / or complete miscarriages, the service is available for
women up to 20 weeks gestation, they are referred to the unit by either
their G.P. or midwife.
Due to routine ultrasound scanning the ward also experiences a number
of
women admitted for medical terminations because an abnormality has
been detected or due to fetal demise. This can be a highly emotional and
sensitive experience for the patient, her family plus the staff that are
involved.
Women who are referred to the ward via their G.P. or midwife are offered
an ultrasound scan to assess the viability of the pregnancy, this takes
place
in another department within the hospital.
Part of my role as a health care support worker is to escort the patients to
the scan department and provide support to them if needed.
The women who attend the hospital have a wide ranging diversity of
circumstances, some of these include age, social / domestic background,
values, beliefs and attitudes. I am aware of my own values, beliefs and
attitude towards pregnancy but always am conscious of displaying a non
judgemental attitude towards each individuals unique circumstances. I
recognise the fact that because I have certain values and beliefs does not
mean the next person shares those same values and beliefs.
On a regular basis I have to escort very young women to the ultrasound
department who may well be on their second or even third pregnancy,
many of these young women are not in a stable relationship. I have
escorted one young woman recently who had discovered she was
pregnant
but did not want to continue with the pregnancy. I was unaware of this
fact until we were actually in the scanning room. The woman did not
show any interest whatsoever in what the ultrasonagrapher was saying to
her and displayed no interest in the monitor which clearly showed the
pregnancy, which was viable. Her body language conveyed to me her
sense of unease, the way she was unable to make eye contact with either
myself or the ultrasonagrapher and what appeared to be an apparent lack
of interest made me feel there was an underlying reason for this. I am
aware that body language is an important part of the communication
process, as nurses we should be aware of it and mindful of the non verbal
clues that patients portray through their body language.
Dimbleby & Burton (1995) suggest that body language has several
elements these include; gesture, facial expression, gaze, posture, body
space and proximity, touch and dress.
I tried to reassure her by speaking to her and touching her lightly on the
arm. It was not until I made physical contact with her that she opened up
and discussed how and why she was feeling the way she was.
She admitted the pregnancy was a mistake and that she had no intention
of
continuing with it. She then went on to apologise to the ultrasonagrapher
and myself for her decision and explained to us that she was very worried
about what we would think of her, especially the nurses on the ward,
at this point I felt great empathy towards the woman. I tried to put her at
ease by explaining to her that none of us were going to judge her, we
were
there to support her through her decision. I emphasised the fact that it was
not an easy decision to come to, one that only she could make and
whatever she decided should be what is right for her and nobody else. My
own personal thoughts were that this woman was very brave in
making the decision to terminate the pregnancy. Personally I feel it is
better to terminate a pregnancy than to bring an unwanted child into the
world who may not be loved and cherished as a child should be. I do
understand that not everybody would share my thoughts and feelings
towards this. She may well of become an unpopular patient with some
members of staff because of her decision although it would be wrong for
nurses` own values and beliefs to interfere with the care being delivered.
On another occasion I had to escort two women and their partners, who
had come from very different social backgrounds, to the ultrasound
department, this occasion was very sensitive. The woman of the first
couple had achieved ten pregnancies, six children were alive and well
four
of which had been fostered to various foster parents because of the
woman’s social background. She has experienced one miscarriage and
had
three pregnancies terminated, the third one being the day before. She had
been admitted onto the ward with abdominal pain and vaginal bleeding.
The woman of the second couple had achieved her first pregnancy after
many years, she was experiencing difficulties with the pregnancy and was
in an emotional state, the pregnancy was very precious to her and her
husband.
Knowing the circumstances of each couple I could not help but feel
empathy for the second couple, I was aware that I should not show a
judgemental attitude towards the first couple because of the obvious
difference in the circumstances.
Once we reached the ultrasound department I became aware of the fact
that the first couple were talking openly to each other about their
circumstances, this was in earshot of the other couple. I could see that
they
were becoming affected by what they were hearing. I made the decision
to
approach the appropriate staff within the department and requested that
the second couple be seen first. I briefly explained the circumstances for
my request remembering the importance of maintaining patient
confidentiality.(Nursing & Midwifery Council 2002).
The couple were seen first and did receive the news that the pregnancy
had failed, they were both extremely upset. I respected the fact that they
needed to be alone in private for a while to come to terms with the sad
news they had just received.
When they felt ready I escorted them back to the ward where I informed
the emergency nurse of the outcome and handed the scan report to her.
The couple were shown to a private room where the doctor had a chat
with them and was able to answer any questions they may of had.
I am often asked questions from patients on the walk back to the ward,
the
most asked question is “What happens now”. I am constantly aware of
the
limitations of my role, if I am able to answer the question then I do but I
always stress to the patients that the trained nurse and the doctor are the
people with the knowledge to explain things to them in greater detail than
I can. If I do not know the answer to their question I am honest and admit
it to them but reassure them that they will have the opportunity to ask any
questions they may well have once on the ward.
I sometimes do find these situations difficult due to the fact that I have a
close family member who is having to spend a large amount of money on
receiving IVF treatment for infertility to no avail as of yet. The affect that
not being able to conceive naturally and having to invest money into
treatment is emotionally upsetting for them.
Introduction
This reflective account discusses the sensitive nature of coping with
situations that can be highly emotive for patients and their families.
It discusses situations where I have had to be non judgemental as well as
empathetic in different circumstances.
Empathy is described as being the most fundamental sense which
involves
understanding the experience, behaviours and feelings of others as they
experience them. (Duxbury, J.)
As nurses it is important that we are aware of our own feelings, values
and
beliefs and how our own behaviour is portrayed to others.
Becoming self aware enables us to look at our personality, we may
discover strengths or weaknesses we were not aware of. We could use
these discoveries to develop our own self esteem which may reflect on
our
relationships and the ability to communicate more effectively both
personally and professionally.
Parbury (1993:p23) states that “self awareness builds a sense of self, this
moves nurses towards a health self concept both as persons and nurses”.
Developing a deeper understanding of oneself makes it possible to
distinguish between our own thoughts and feelings and those of the
patient.
Sundeen et al (1998) suggest that a firm understanding and acceptance of
our own self will allow nurses to acknowledge a patients difference and
individuality.
To link the theory of self awareness to practice I have reflected on a
number of occasions where I have had to respect the patient as an
individual with differing thoughts and feelings to myself.
I am always conscious of not displaying a judgemental attitude in what
can be upsetting circumstances. I acknowledge the fact though that as
nurses we cannot be expected to behave in a robotic way with our
emotions but through self awareness they can be managed appropriately.
Conclusion
Although the two couples discussed came from very different social
backgrounds with differing circumstances the need to treat each person as
an individual is imperative. Patients have the right to be treated with
respect and dignity at all times regardless of their decisions and choices.
However I do personally feel that the two woman who had achieved
unwanted pregnancies, especially the woman who had achieved
numerous pregnancies should be given some form of education in the use
of contraception to prevent any more unwanted pregnancies.
Ewles & Simnett (1992) suggest that the aim of education is to give
information and ensure knowledge and understanding to enable well
informed decisions to be made.
Education may change their attitude towards contraception and teach
them
how to prevent any further unwanted pregnancies. They would then be
able to make their own decision about whether to achieve a pregnancy or
not.
This choice would prevent them from having to go through the upset and
trauma of terminating any future unwanted pregnancies.
I did empathise with the first patient I discussed, she made the decision
that it was not the right time for her to have a child, she had made a
mistake and was having to go through the trauma of terminating the
pregnancy. In this situation it is vital that the woman concerned should
not
be made to feel that she is being judged by other people. The wrong
attitude could lead to feelings of guilt on the patients conscience which
may have lasting physiological effects for many months if not years.
My experience of this situation has taught me the importance of self
awareness and how each individual should be treated with respect and
dignity at all times. We should treat individuals as we ourselves would
expect to be treated if we were a patient.
References
Dimbley & Burton (ed) (1995)
Interpersonal Communication in Nursing
USA, Churchill Livingstone.
Duxbury, J. (2000)
Difficult Patients
Oxford, Butterworth – Heinemann.
Ewles, L. & Simnett, I. (1992)
Promoting Health, 2nd ed.
Middlesex, Scutari Press.
Nursing & Midwifery Council (2002)
Code of Professional Conduct
Parbury, J. (1993)
Patient & Person, developing interpersonal skills in nursing
London, Churchill Livingstone.
Sundeen, S.J. et al (1989)
Nurse – Client Interaction, 4th ed
St Louis, The C.V. Mosby Company
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